Republicans have put forth health care reform proposals that include provisions that eliminate pre-existing conditions, end the policy of rescission, allow people to stay on their parent’s health insurance policy until the age of 26, and offer tax subsidies to help consumers pay for their health insurance. Additionally, Republicans have come out in favor of allowing consumers to buy health insurance across state lines, back the creation of high risk pools for those with serious ailments. Republicans also have stated they are in favor of allowing small businesses to pool together in order to get more affordable coverage. They have also stated that a key goal of a conservative ACA alternative is to allow insurance companies compete in a competitive marketplace. Changes to President Bush’s Medicare expansion would help finance $700 billion of the plan, a proposal adopted by Rep. Paul Ryan’s 2012 budget.
Ryan’s health care plan is actually very similar to the Affordable Care Act. The plan provides subsidies to help seniors buy insurance on the private market. The key difference between the two plans is the composition of the risk pool. If high risk patients all purchase health care at the same time, premiums will rise as insurers calculate higher costs for older people. In the ACA, young people are forced into the system to offset the costs of older recipients.
Most of the current proposals from Republicans are/have been implemented in the Affordable Care Act already. Nearly ten million US citizens have received health care under the ACA, making it even more difficult to repeal and start from scratch. This means a full repeal of the law is unlikely. What is more likely is a series of reforms to proposals in the existing law.
Republicans are against the individual mandate, a provision of the law that requires Americans to buy health insurance, this would almost certainly be one of the first parts of the law to come under heavy fire, since it is also the least supported among the American electorate. Republicans would also rescind the tax increases in the ACA, particularly the medical device tax. In addition, Republicans would advocate tort reform as former President George W. Bush did as governor of Texas. This specific provision has the largest likelihood of approval from President Obama, who signaled openness to enacting tort reform in 2010.
The biggest challenge to these reforms would be the decision to repeal the taxes that help fund the law, and the decision to not mandate coverage. Currently, the Congressional Budget Office has concluded the Affordable Care Act will decrease the deficit. Removing the funding mechanism for the law would reform the Act in such a way that it would likely increase the deficit. Repealing the individual mandate would likely raise insurance premiums as fewer younger people would be forced into the system to dilute the risk pool.
Republicans are preparing an alternative health care plan to pre-empt a potential Supreme Court decision that could invalidate the tax subsidies given to consumers in states where no state health exchanges exist. If the Supreme Court invalidates that statute of the law, it would essentially drive a dagger through the heart of the Affordable Care Act. Health experts expect the rate of the uninsured to skyrocket, and premiums will rise nationwide if the Supreme Court does indeed invalidate most consumer tax subsidies.
As a result, Senate Republicans are putting together a detailed alternative to the ACA, partly to deal with the possible Supreme Court decision, and partly to have a fully fleshed out health care plan to run on in 2016.